Rheumatoid arthritis was associated with significantly prolonged isovolumetric relaxation time (MD 9.67 msec; 95% CI 5.78-13.56; P<0.00001) and other parameters of diastolic dysfunction.
Meta-Analysis (n=5,836)
Do patients with rheumatoid arthritis have an increased prevalence of echocardiographic parameters indicative of diastolic dysfunction compared to controls?
Patients with rheumatoid arthritis are more likely to exhibit echocardiographic parameters of diastolic dysfunction, higher systolic pulmonary artery pressures, and larger left atrial sizes compared to controls.
Effect estimate: Mean difference 9.67 msec (95% CI 5.78, 13.56)
p-value: p=<0.00001
OBJECTIVE: To determine if the prevalence of diastolic dysfunction is increased in rheumatoid arthritis (RA) patients. METHODS: We conducted a time- and language-restricted literature search to identify studies conducted to compare echocardiographic parameters in patients with RA and controls. The mean difference for echocardiographic variables of interest was calculated using a random-effects model. A systematic review of the literature was performed. RESULTS: A total of 25 studies reporting on 5,836 subjects (1,614 with RA) were included. Results reflect mean differences, with positive values denoting higher values in RA patients. Patients with RA had larger mean left atrial dimension (mean difference 0.09 cm 95% confidence interval (95% CI) 0.01, 0.17; P = 0.02), higher left ventricular mass index (mean difference 6.2 gm/m(2) 95% CI 1.08, 11.33; P = 0.02), higher mean systolic pulmonary artery pressure (mean difference 5.87 mm Hg 95% CI 4.36, 7.38; P < 0.00001), prolonged isovolumetric relaxation time (mean difference 9.67 msec 95% CI 5.78, 13.56; P < 0.00001), and higher transmitral A wave velocity (mean difference 0.13 meters/second 95% CI 0.07, 0.18; P < 0.00001) compared to controls. A subanalysis of 2,183 subjects excluding 2 large unmatched studies showed the same results, with the exception that patients with RA had a lower mitral E/A ratio (mean difference -0.17 95% CI -0.25, -0.09; P < 0.00001), suggestive of diastolic dysfunction. There were no differences in left ventricular ejection fraction (%), transmitral E wave velocity (meters/second), and mitral deceleration time (msec). CONCLUSION: Patients with RA were more likely to have echocardiographic parameters of diastolic dysfunction, and have higher systolic pulmonary artery pressures and larger left atrial sizes.
Aslam et al. (Sun,) conducted a meta-analysis in Rheumatoid arthritis (n=5,836). Rheumatoid arthritis vs. Controls was evaluated on Isovolumetric relaxation time (Mean difference 9.67 msec, 95% CI 5.78, 13.56, p=<0.00001). Rheumatoid arthritis was associated with significantly prolonged isovolumetric relaxation time (MD 9.67 msec; 95% CI 5.78-13.56; P<0.00001) and other parameters of diastolic dysfunction.
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